A listener, Brian Katan, wrote to suggest adding ondansetron to the awake intubation procedure. Now this is interesting, because I don't want the patient to vomit from ramming things into the back of her throat, but the mechanism is not nausea–it is the gag reflex. So, the question is: does ondansetron affect the gag reflex? Turns out it does…
Evaluation of the efficacy of oral ondansetron on gag reflex in soft palate and palatine tonsil areas
So now, ondansetron 4 mg IVP has been added to the airway checklist. Thanks Brian!
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics - April 17, 2021
- EMCrit 295 – Resuscitation Room Readiness - April 3, 2021
- EMCrit 294 – Acute Crit Care Grand Rounds with Josh Farkas - March 17, 2021
[…] is also an interesting article on the EMCrit Blog suggesting that ondanstron suppresses the gag reflex and may be useful in awake […]
IV Granisteron has also been looked at (successfully, though small groups but blinded and placebo control)
I used to use it for this reason (when it was still in our cupboards) for ENT lists; have since switched to Ondansetron
Never occured to me to use it in AFO intubation as well though; good tip!
-John
I routinely use it for any procedural sedation
OK, interesting information. I just administered Ondansetron 4 mg IVP to my patient I am sedating just now. Some 15 years ago, I was privy to an unusual side effect of Ondansetron in a patient I cared for that underwent anterior cervical discectomy and fusion. He was a tall, thin gentleman in his early 40’s with a history of herniated cervical discs. Surgical procedure, airway management and anesthetic was unremarkable, and I was making a brief visit to the patient the afternoon of postop day 1 when the story gets interesting. The patient was recovering well, and had just returned… Read more »
Crazy stuff, ours come in little bags that have to drip in. Good to know.
I never, ever, ever just walk up to an IV and jam the medication in unless it is clearly indicated, i.e. adenosine challenge or RSI procedure. I teach and stress the need to dilute and administer slowly most medications as we give it. Working in the ED, I hang a bag of NS after I start most of my IV’s to ensure the pain and nasea medications are given with a little dilution to avoid deleterious effects. Thoughts.
Can I get an Amen? Amen!
Amen!
Sounds good to me. You never want full drug in 1st pass except for the situations you mentioned.
[…] ondansetron affect the gag reflex? Turns out it does…..Ondanestron for Awake Intubation – the power of FOAMed keeping us educated […]